Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 68-year-old male presented with cough and sputum. He had suffered from these symptoms for ten years prior to admission. Chest roentgenogram revealed reticulonodular shadows in the lower fields of both lungs. CT scan of the chest revealed an interstitial pattern in the lower field of both lungs. Honeycombing and bullous pattern were also present in the subpleural area. The patient had a history of dust and asbestos inhalation while working as an electrician. Eosinophilia of the peripheral blood and BALF, and a slightly increased serum IgE concentration were noted. Open lung biopsy revealed interstitial fibrosis with intra-alveolar macrophage accumulation and asbestos bodies. The histopathological features resembled UIP and DIP, although DIP is uncommon in pulmonary asbestosis. The slightly increased serum IgE concentration was considered to be an additional effect of asbestos. This is a case of pulmonary asbestosis with intriguing immunological and histopathological features.
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PMID:[A case of pulmonary asbestosis with slightly increased serum IgE concentration and histopathological changes resembling DIP]. 851 2

A 56-year-old man with idiopathic pulmonary fibrosis developed acute symptoms, including fever and cough. Chest X-ray and CT scan films revealed consolidations and ground glass opacities in the bilateral lungs suggestive of massive pneumonia and acute respiratory distress syndrome (ARDS). Microscopic examination by a transbronchial lung biopsy from the right middle lobe demonstrated numerous hyphae of aspergillus. Despite treatment with anti-fungal agents, respiratory failure rapidly progressed, and the patient died on the 21st hospital day. Postmortem examination of the lung showed multiple abscesses with hyphae of aspergillus invading into small pulmonary artery and alveoli, which were the characteristic findings of invasive pulmonary aspergillosis (IPA). In addition, diffuse alveolar damage was also present, associated with the typical features of UIP such as honeycombing in the bilateral lungs. The serum anti-influenza B virus antibody was high at 512-fold. Therefore, it was speculated that influenza B virus infection triggered superimposed aspergillus infection leading to fatal IPA associated with ARDS.
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PMID:[Fatal invasive pulmonary aspergillosis triggered by influenza B virus infection in an individual with idiopathic pulmonary fibrosis]. 1661 65

A 72-year-old woman was admitted to our hospital complaining of dry cough and dyspnea on effort for 9 months. Her chest HRCT findings showed diffuse reticular opacities, ground-glass opacities, and interlobular septal thickening with subpleural and peribronchovascular distribution, not typical of IPF/UIP. BAL revealed mild lymphocytosis and elevated CD4/CD8 ratio. Since TBLB was not diagnostic, we performed VATS biopsy. The pathological finding by VATS biopsy revealed collapse, fibrosis, and scar formation in both subpleural and intralobular regions with small granuloma, consistent with chronic hypersensitivity pneumonitis. Both antibodies in serum to pigeon dropping extract and inhalation provocation test using avian dropping extracts were positive. and therefore we diagnosed chronic bird fancier's lung. We should suspect chronic hypersensitivity pneumonitis in cases with HRCT findings atypical of IPF/UIP. and examine antibodies against specific antigens and perform VATS biopsy.
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PMID:[A case of chronic bird fancier's lung in which VATS biopsy was diagnostically useful]. 1818 47

Interstitial lung disease (ILD) is a common extra-articular manifestation of rheumatoid arthritis (RA) and a significant cause of morbidity and mortality. Usual interstitial pneumonia and nonspecific interstitial pneumonia seem to be the most frequent patterns in RA patients with ILD, although the proportion of patients with usual interstitial pneumonia is higher than among patients with other systemic rheumatic autoimmune diseases. RA patients with ILD most frequently present with chronic symptoms of cough and dyspnea when climbing stairs or walking uphill. A physical examination may reveal inhalatory crackles and a pulmonary function test demonstrates restrictive physiology, often with reduced diffusing capacity. High-resolution computed tomography is generally sufficient to confirm a diagnosis of ILD, although a minority of cases may require a surgical lung biopsy. Conventional disease-modifying antirheumatic drugs such as methotrexate (MTX) or leflunomide (LEF) and biological agents such as TNF-blocking agents or rituximab may trigger or aggravate ILD in RA patients, and infections may contribute to increased mortality in such patients. LEF should not be used in patients with a history of MTX pneumonitis. The prevalence of interstitial pneumonia among RA patients treated with anti-TNF agents ranges from 0.5 to 3%; however, as the evidence that anti-TNF increases or decreases the risk of ILD is controversial, it is not clear whether this indicates more severe RA requiring biological therapy or the effect of exposure to potentially toxic drugs such as MTX or LEF. The development of treatment-related ILD is a paradoxical adverse event, and patients should be warned about this rare but serious complication of biological or disease-modifying antirheumatic drug therapy.
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PMID:Lung involvement and drug-induced lung disease in patients with rheumatoid arthritis. 2389 35

A 74-year-old non-smoker female presented to our attention with a history of dyspnea and cough. CT scan revealed multiple areas of patchy ground glass attenuation associated to a diffuse mosaic oligoemia. Scattered bilateral subcentimetric pulmonary nodules were also present. Patient underwent a surgical lung biopsy. Specimens showed features of diffuse neuroendocrine hyperplasia, microhoneycombing, fibroblast foci. A final diagnosis of diffuse neuroendocrine hyperplasia with obliterative bronchiolitis and UIP was rendered.
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PMID:Diffuse Neuroendocrine Hyperplasia with Obliterative Bronchiolitis and Usual Interstitial Pneumonia: An Unusual "Headcheese Pattern" with Nodules. 2644 75

Idiopathic pleuroparenchymal fibroelastosis (IPPFE) was recognized as a rare new entity. We report the case of a 63 years old female suffering from progressive dyspnea and dry cough for three years. Two years before admission to our hospital, idiopathic pulmonary fibrosis (IPF) was diagnosed in another hospital and treatment with prednisolone and N-acetylcysteine (NAC) was commenced. At admission HRCT showed upper lobe dominant fibrosis and associated pleural thickening. Surgical biopsies were re-evaluated and revealed fibroelastosis with pleural thickening and a probable UIP pattern, consistent with idiopathic PPFE. Treatment with pirfenidone was initiated due to progression under prednisolone and NAC. Upper lobe predominant pleural thickening with associated subpleural fibrotic changes should raise suspicion of PPFE.
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PMID:Idiopathic pleuroparenchymal fibroelastosis (PPFE) - A case study of a rare entity. 2878 Sep 89

Rheumatoid arthritis-related interstitial pneumonia with a usual interstitial pneumonia (RA-UIP) has a poor prognosis and a new treatment strategy is required. The antifibrotic agent nintedanib reduces the annual rate of decline in forced vital capacity (FVC) in idiopathic pulmonary fibrosis (IPF) patients. Recently, the potential efficacy of antifibrotic agents against chronic progressive fibrotic diseases including RA-UIP has been attracting attention. A 74-year-old man diagnosed with IPF on high-resolution computed tomography (HRCT). His FVC was decreasing over time, and his exertional dyspnea and cough had progressed with progression of reticulation on imaging. He was treated with nintedanib, which resulted in decreased coughing together with a reduction in FVC decline, from -11.6%/year to -5.2%/year. A swollen joint appeared eight months after this intervention, and he was diagnosed with rheumatoid arthritis. In this patient, nintedanib was effective against RA-UIP. This is the first case in which nintedanib was shown to be effective for RA-UIP.
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PMID:A successful treatment of rheumatoid arthritis-related interstitial pneumonia with nintedanib. 3053 76

Rheumatoid arthritis (RA) is a type of inflammatory arthritis that affects ~1% of the general population. Although arthritis is the cardinal symptom, many extra-articular manifestations can occur. Lung involvement and particularly interstitial lung disease (ILD) is among the most common. Although ILD can occur as part of the natural history of RA (RA-ILD), pulmonary fibrosis has been also linked with methotrexate (MTX); a condition also known as MTX-pneumonitis (M-pneu). This review aims to discuss epidemiological, diagnostic, imaging and histopathological features, risk factors, and treatment options in RA-ILD and M-pneu. M-pneu, usually has an acute/subacute course characterized by cough, dyspnea and fever. Several risk factors, including genetic and environmental factors have been suggested, but none have been validated. The diagnosis is based on clinical and radiologic findings which are mostly consistent with non-specific interstitial pneumonia (NSIP), more so than bronchiolitis obliterans organizing pneumonia (BOOP). Histological findings include interstitial infiltrates by lymphocytes, histiocytes, and eosinophils with or without non-caseating granulomas. Treatment requires immediate cessation of MTX and commencement of glucocorticoids. RA-ILD shares the same symptomatology with M-pneu. However, it usually has a more chronic course. RA-ILD occurs in about 3-5% of RA patients, although this percentage is significantly increased when radiologic criteria are used. Usual interstitial pneumonia (UIP) and NSIP are the most common radiologic patterns. Several risk factors have been identified for RA-ILD including smoking, male gender, and positivity for anti-citrullinated peptide antibodies and rheumatoid factor. Diagnosis is based on clinical and radiologic findings while pulmonary function tests may demonstrate a restrictive pattern. Although no clear guidelines exist for RA-ILD treatment, glucocorticoids and conventional disease modifying antirheumatic drugs (DMARDs) like MTX or leflunomide, as well as treatment with biologic DMARDs can be effective. There is limited evidence that rituximab, abatacept, and tocilizumab are better options compared to TNF-inhibitors.
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PMID:Methotrexate-Associated Pneumonitis and Rheumatoid Arthritis-Interstitial Lung Disease: Current Concepts for the Diagnosis and Treatment. 3170 58

It is uncommon to diagnose usual interstitial pneumonitis as a unilateral presentation. We present a case of an 81-year-old current smoker who presented with exertional dyspnea and dry cough. The patient had right sided UIP pattern in the CT chest along with hiatus hernia. The etiology for the unilateral lung involvement was postulated to be due to the hiatus hernia leading to gastro-esophageal reflux disease (GERD) which caused micro aspirations leading to lung injury and fibroblast activation. Whether this can be prevented by anti-reflux medications needs further research. Our patient was managed with pirfenidone, metered dose inhalers containing tiotropium and proton-pump inhibitors Thus, a high index of suspicion for underlying gastro-esophageal reflux must be kept in such patients to arrive at an early diagnosis and start treatment.
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PMID:A case of an 81-year-old with cough and dyspnea. 3316 19